Ungathanda ukwazi ukuthi yini a umshwalense oyinhlekelele futhi isebenza kanjani? Kulesi sihloko sikunikeza ulwazi oludingayo ukuze ujabulele lolu hlobo lomshwalense, olubaluleke kakhulu ekuthuleni kwengqondo yabantu.
Umshwalense Wenhlekelele
I-World Health Organization (WHO) ichaza ezempilo ngale ndlela elandelayo:
Impilo yisimo sokuphila kahle ngokomzimba, ngokwengqondo nangokwenhlalo hhayi nje ukungabibikho kwezifo noma ubuthakathaka.
Uma kucatshangelwa ukuthi impilo iyimpahla engokomthetho ebalulekile evikelwe iSifundazwe SaseChile, lapho kuvela izimo ezifaka impilo engcupheni noma eziyibeka engozini, ezibangela ukungalingani kwezomnotho, izinsizakalo ziyasetshenziswa ukuze kuliwe nalesi senzo, esifana nalokho okubizwa ngokuthi. umshuwalense wezempilo oyinhlekelele. Uma uthanda umshuwalense wokuphila, funda isihloko esilandelayo Kungani Kubalulekile Ukuqasha Umshwalense Wokuphila?
Uyini umshwalense oyinhlekelele?
El ephephile inhlekelele Kuwuhlobo lohlelo lwezempilo olunikeza usizo ngezikhathi zezimo eziphuthumayo, kodwa futhi lunikeza ukunakekelwa kokuvimbela. Lezi zinhlelo zezempilo eziyinhlekelele zinezindleko eziphansi zamaphrimiyamu anyanga zonke, kodwa ama-deductibles aphezulu.
Umsebenzisi wepholisi kufanele akhokhele noma yisiphi isimo esiphuthumayo sezokwelapha esitholiwe kuze kufike enanini lemali edonswayo kanye nokunakekelwa okuningi kokuvikela kukhaviwe ku-100%.
Mayelana nokuhlinzekwa kwezempilo okuyinhlekelele, kutholakala kubantu abaneminyaka engaphansi kwengama-30 abafuna ukukhokhelwa okungenani kanye namaphrimiyamu aphansi anyanga zonke, kanye nalabo banoma iyiphi iminyaka yobudala abafanelekile ngenxa yobunzima bezomnotho, noma abacela ukukhululwa ebunzimeni.
Lesi sicelo sokuhoxiswa sisho ukungakwazi ukukhokhela umshwalense wokunakekelwa kwezempilo ngenxa yezimo ezingalindelekile njengokulahlekelwa ikhaya noma ukugcwalisa icala lokuqothuka noma ezinye izindlela okufanele zicatshangelwe.
Ngalo mqondo, ukuba nomshwalense oyinhlekelele kuyindlela ebalulekile yokuvikela, ukuvimbela ukunakekelwa kwezempilo okuseqophelweni eliphezulu kanye nokunciphisa izindleko eziholela ekunakekelweni kokwelapha kunoma yisiphi isenzakalo esingalindelekile semvelo yezempilo. Ngaphambi kokuqhubeka nokuthuthukiswa kwalesi sihloko, kulula ukwazi uhlobo lomshwalense, ukuthi usebenza kanjani kanye nemibandela okufanele icatshangelwe lapho ukhetha owodwa.
Izinsizakalo eziphathelene nempilo e-Chile zibiza kakhulu, ngakho-ke kulula ukuba nenqubomgomo yomshwalense wezempilo ehambisanayo esebenza njengokwesekwa kwezimali ukuze kuhlangatshezwane nezindleko ezitholakala ekubonisaneni nokunakekelwa kwezokwelapha.
Kodwa-ke, uma kuziwa ezinkambisweni, ezinjongo yazo iwukuvimbela ngokuphathelene nokunciphisa umthelela wezomnotho, ovela enkingeni yezempilo engathi sína, yisikhathi lapho umshuwalense oyinhlekelele uqala ukusebenza, izakhamuzi zaseChile ezimweni eziningi azicaci kahle izinzuzo zayo.
Emakethe yaseChile, kunezinhlobo ezimbili zalolu hlobo lomshwalense oyinhlekelele:
- Kubandakanya ukufaka isandla kumshwalense wezempilo ohambisanayo kanye nohlelo lwezempilo, kungakhathaliseki ukuthi uvela ku-National Health Fund (Fonasa) noma i-Isapre.
- Ihlanganisa izehlakalo ezithile zezempilo eziyinhlekelele.
Ukunikezwa kwalolu hlobo lomshwalense eRiphabhulikhi yaseChile kukhuthazwa Isikhwama Sikazwelonke Sezempilo (i-Fonasa) kanye ne-isapre kanye nazo zonke izinkampani zomshwalense ezizimele; kuwumfanekiso ukuveza eminye yemininingwane yawo.
Izindlela zomshwalense oyinhlekelele
Kunezinhlobo ezahlukene zomshwalense oyinhlekelele, esizozichaza ngezansi:
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Umshwalense Wenhlekelele Wesikhwama Sikazwelonke Sezempilo
Izici, kanye nezinzuzo zalesi sikhwama, ngokusho koMphathi Wezempilo, ibhonasi eyinhlekelele ye-Fonasa enamaphesenti angu-100 wezindleko kodwa kuphela uma uya ezikhungweni ezikhethwe yisiKhwama.
Kuyadingeka ukuqonda ukuthi ukukhokhelwa kwakho kuqinisekisiwe ezikhungweni zezokwelapha ezixhumene nesikhwama. Ngaphezu kwalokho, lo mshwalense we-Fonasa usebenza kuphela kulezi zifo ezilandelayo, ngokusho kwe-Med Guide portal:
- I-Hemodialysis kanye ne-peritoneodialysis
- Izinzuzo Zokuhlinzwa Kwenhliziyo
- Izinzuzo Zokuhlinzwa Kwezinzwa
- I-Scoliosis
- Ukufakelwa kwezinso
- ukufakelwa kwesibindi
- Ukunakekelwa Okuphelele Kwesiguli Esihlaselwe
- Ukunakekelwa Okuphuthumayo Kwesiguli Esishisiwe
- Izinzuzo ze-Chemotherapy Group
- Izinzuzo ze-Radiotherapy Group
- Ukwelashwa kwe-HIV nge-Pharmacological
- Ukunakekelwa Okuphuthumayo Kweziguli Ezine-Complex Trauma
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Isapre Catastrophic Insurance
- Ukuthola Okungeziwe Kwezifo Eziyinhlekelele (CAEC) kuhlanganisa inzuzo eyengeziwe enikezwa i-ISAPRE, yazisa Umphathi Wezempilo. Ukusebenziseka kwayo kuhlanganisa ukunciphisa izimo ezibiza kakhulu, kungakhathaliseki ukuthi zihlobene nesifo esithile, nakuba kunezinzuzo ezithile ezingakhaviwe.
- Ukufeza izidingo ezithile ezibaluliwe, ama-CAEC amboza u-100% wezindleko zelungu ezeqa imali edonswayo, noma inani elihambisana nokukhava lowo ofakwe kumshwalense.
- Kubalulekile ukugqamisa ukuthi le nketho iyatholakala cishe kuwo wonke ama-isapre, bambalwa abantu abenza lokhu kukhava kusebenze. Izizathu zokuthi kungani izinhlangano ezisebenzisana nazo ezimbalwa zisizakala ngama-CAEC ukuntuleka kolwazi kanye nenkolelo yokuthi adala izindleko ezengeziwe.
3.-I-Catastrophic Insurance ehlinzekwa izinkampani zomshwalense
Uma inkundla yokuqhathanisa yohlelo lwezempilo lwe-Qué Plan ithathwa njengereferensi, ukuphromothwa kwale mikhiqizo kubonisa indlela yokukhetha ukufakwa, okungukuthi, uma kuyingxenye noma ingqikithi yezindleko ezikhiqizwa iziqephu eziyinhlekelele ezihlobene nempilo; Lesi simo asibonakali kuzinqubomgomo ezinikezwa yi-Fonasa ne-Isapre.
Kodwa-ke, kubalulekile ukwazi ukuthi umshwalense oyinhlekelele usebenza noma usebenza njengembuyiselo, uma ukumbozwa kwe-Fonasa ne-isapre kweqiwe, kodwa ama-CAEC acabanga kuzinqubomgomo zawo ukukhetha kwenkokhelo yemali edonswayo.
Ngaphakathi kwezimpawu zalolu hlobo lwenqubomgomo olunikezwa izinkampani zomshwalense, ngokuvamile zicabangela ukujabulela le nzuzo kubantu abasebangeni eliphakathi kweminyaka eyi-18 nengama-80 ubudala, ezikhipha ngokuphelele ngaphandle ukufakwa komshuwalense kubantu abanezifo ezivele zikhona, ubuhle. noma ukwelashwa kwengqondo.
Usebenza kanjani umshwalense oyinhlekelele?
Ngesikhathi umsebenzisi enquma ukwenza inkontileka yalolu hlobo lomshwalense wezempilo oyinhlekelele, kufanele azi izici zenqubomgomo ngaphambi kokusayina inkontileka, imibuzo kufanele ibuzwe njengokuthi: ukuba khona noma cha kwe-deductible kanye nenani layo, yiziphi izicelo ezicatshangelwayo kanye nemibandela yokuqashelwa kwazo.
Umshwalense oyinhlekelele we-Fonasa usebenza ngokuzenzakalelayo, ngaphandle kokuba khona kwenkontileka yokufinyelela lesi simangalo, ikhwalithi ye-affiliate kuphela eyanele; Kuwumbandela obalulekile kulo mgomo ukuya esikhungweni sezempilo sikahulumeni.
Uma umsebenzisi enquma ukuthatha umshwalense oyinhlekelele oxhaswe yi-ISAPRE, ukumbozwa kufanele kusebenze ngaphambi kokuba ukulahlekelwa kwenzeke noma lapho ukuxilongwa kwezokwelapha kungase kuphenduke ukugula okuyinhlekelele ngokusekelwe ezindlekweni zezimangalo ezizikhiqizayo. Uma kunjalo, umsebenzisi kufanele aye esikhungweni sakhe futhi agcwalise ifomu elithi “Isicelo sokufakwa kunethiwekhi evaliwe ye-CAEC ne-GES-CAEC.
Umshwalense oyinhlekelele owengeziwe
Okulandelayo, sizophendula imibuzo evame ukubuzwa ongase uzibuze yona njengomzuzi womshwalense oyinhlekelele noma uma uthanda ukuthola inkontileka yalolu hlobo lomshwalense.
Hlobo luni lokunakekelwa kwezempilo olukhava umshwalense wezempilo oyinhlekelele?
Uma uhlelo lwakho oludonswayo selukhokhiwe, ukuvikeleka okuyinhlekelele kufanele kukhokhele izingozi, ukulimala okungalindelekile, izifo eziphuthumayo eziphuthumayo. Lezi zinhlelo zingase zibe nokufakwa okungu-100% kwezinye izinsiza zokuvikela, ukudutshulwa komkhuhlane, ukuhlolwa okujwayelekile, noma ukuhlolwa kwaminyaka yonke. Iningi lalezi zinhlelo lihlanganisa okungenani ukuvakashela udokotela oyinhloko kathathu.
Ungakhetha kanjani umshwalense wenhlekelele ofaneleka kakhulu?
Manje njengoba sewazi ukuthi uyini umshwalense oyinhlekelele, owakho nokuthi usetshenziswa kanjani, siyazivumela ukuthi siphakamise izincomo ezithile eziwusizo lapho sikhetha inketho engcono kakhulu yokujabulela izinzuzo zenqubomgomo yakho.
- Cabanga ngokufakwa kwendawo. Ukwamukelwa kwezikhungo zezempilo ezitholakala kuyo yonke indawo kazwelonke.
- Bheka imbuyiselo kanye nokuthi kuyini ukwabiwa kwakho (okuhlanganisa izindleko zesibhedlela, udokotela, iziguli ezingalaliswanga kanye nezemithi).
- Ngaso sonke isikhathi funda imibhalo emihle futhi ungasayini lutho uze uqiniseke ukuthi uyakuqonda konke okushiwo yinqubomgomo.
- Dinga inombolo yenqubomgomo futhi uyigcine endaweni ephephile ngomqondo wokuyisebenzisa esigamekweni esiyinhlekelele esingalindelekile futhi waziwe izihlobo zakho.
- Kubalulekile ukuqonda ukuthi yiziphi izici ezikhona futhi azihlanganiswa nohlelo olukhethile.
Khumbula ukuthi Inhlangano Yezempilo Yomhlaba ikhombisa impilo njengenkimbinkimbi esemqoka, umphumela wayo okuyibhalansi ye-harmonic yomuntu oqagela inhlalakahle ngaphakathi kwenhlangano yomuntu lapho exhumana khona.
Ngendlela efanayo, ibheka impilo njengelungelo lomuntu futhi ifakiwe emthethweni waseChile, ngenxa yalokho uMbuso WaseChile unesibopho sokuqinisekisa ukuthi leli lungelo lithotshelwa ngokugcwele. Kungumsebenzi womphakathi nenani labantu bazo zonke izigaba ezakha umphakathi.
Nakhu okunye okubalulekile okulalelwayo nokubonwayo ukuze uqhubeke ufunda ngomshwalense oyinhlekelele.